This is the first post in a 2-part series about how I’ve arrived at a decision about having further SRS, specifically ALT phalloplasty. The time line graphic highlights key events that helped shape my final decision, and illustrates the steady increase of body dysphoria. Full text is below the graphic, and further details will be published in the next article in this series.
Also see:
- The Road to Phalloplasty, Part 2: Funding Frustrations
- The Road to Phalloplasty, Part 3: Hurdles Ahead
For those of you considering metoidioplasty or phalloplasty, do you see any similarities between my process and your own?
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<a href="https://genderoutlaw.wordpress.com/2012/12/16/phalloplasty-1"><img src="https://genderoutlaw.wordpress.com/wp-content/uploads/2012/12/theroadtophalloplasty.jpg" alt="The Road to Phalloplasty" title="The Road to Phalloplasty" width="600" height="1200" /></a><br/><a href="https://genderoutlaw.wordpress.com/">Gender Outlaw Blog</a>
10/01/07
I begin my transition. I feel certain that genital reconstructive surgery is not in my future.
08/01/08
I start researching surgeons who perform metoidioplasty with urethral extension and scrotoplasty. I’m disappointed that top surgery alone didn’t “do it” for me.
11/02/08
I publish a series of posts on metoidioplasty surgeons. I’m particularly impressed with the ring metoidioplasty procedure performed by Dr. Bowers and Dr. McGinn, and with Dr. Miro‘s meta procedure.
03/12/09
I undergo hysterectomy (LAVH-BSO) and suffer from an iatrogenic VVF complication. I swear to myself that after healing from this I won’t have any more surgeries. I’m too scared of another complication.
05/19/09
I heal from the VVF complication without surgical intervention. (The urologist calls it “a miracle.”) I’m so thankful that I resolve to envision my life without having further SRS. This turns out to be unrealistic and in a few short months I’m back to researching my surgery options.
08/01/09
My doctor requests funding from MSP of BC for metoidioplasty on my behalf. There is no funding available and we know this; the letter is strategic, part advocacy effort and part of getting me “in line” for future SRS funding.
09/05/09
At the Gender Odyssey conference in Seattle, I attend a presentation by Dr. Meltzer and Dr. Webb on FTM bottom surgery, and have an in-person consultation with Dr. Meltzer regarding metoidioplasty with vaginectomy, urethroplasty, and scrotoplasty. I’m very impressed, and for the next two years my focus remained fixed on having a metoidioplasty performed by Dr. Meltzer.
08/07/11
I attend the 10th annual Gender Odyssey conference and once again take in Dr. Meltzer’s presentation on FTM bottom surgeries, adding to the knowledge I’ve acquired on the topic over the last couple of years. While at the conference, I learn that the push for funding in BC for FTM bottom surgeries has progressed, and it’s expected that funding for both metoidioplasty and phalloplasty will be available within two years.
This news has a motivating effect on me. I re-assess my surgery goals and determine that metoidioplasty will no longer satisfy my needs. While the radial forearm and MLD phalloplasty procedures remain outside my interest, I’m intrigued by Dr. Meltzer’s pedicled phalloplasty using a groin flap.
12/22/11
At my request, my doctor once again requests MSP funding on my behalf, this time for phalloplasty. There’s still no funding available and we know this; the letter is strategic. (Also see 08/01/09.)
04/19/12
I get official confirmation that, “[MSP is] seeking Ministry approval to add phalloplasty to the list of insured services under MSP.”
09/14/12
I receive an email from my contact at MSP confirming that funding for phalloplasty and metoidioplasty will now be offered for up to five men per year. Patients must see Dr. Brassard in Montreal for these surgeries. MSP will cover the costs of the surgery itself but patients will need to cover travel expenses for their initial consultation in Montreal, getting to/from Montreal for surgery, and the stay at the recovery facility.
This news is officially announced at the CPATH conference in Winnipeg, Sept. 21-23, 2012, and Rabble.ca subsequently breaks the story on Oct. 3, 2012.
09/18/12
I speak on the phone with Dr. Curtis Crane, a reconstructive urologist and plastic surgeon in San Francisco who performs the full range of both MTF and FTM surgeries, including three variations of free flap phalloplasty. We discuss the procedures around reinnervating a Meltzer pedicled phalloplasty, as well as the ALT phalloplasty procedure.
12/14/12
I have a second phone conversation with Dr. Crane and ask more detailed questions about nerve anastomosis in a pedicled phalloplasty. While the possibilities are interesting, it’s starting to look like a roundabout way to get the results I seek. My research over the last few months has me leaning heavily toward ALT phalloplasty and the answers I get today from Dr. Crane further cement my resolve. ALT phalloplasty it is!
Gender Outlaw 
Congrats on coming to a decision.
Congrats on finding what you need.
Hey, this is similar to how I felt in a way but I’ve always focused on having phalloplasty. I’m awaiting an appointment at the gender clinic now to get a referal for radial forearm phalloplasty. All the best and good look 🙂
Congrats Josh! I think its a good choice… obviously since I chose the same surgeon. Good luck to you!
Very helpful process laid out for others to glean insight from. Thanks, brother!!
It’s been awhile since we last talked. I hope you still remember me from three years ago when I contacted you regarding needing to transition. I took your advice and had the gender therapy and now…. three later I am on my 15th month of transition and have recently had chest sx with Dr. Garramone. I am booked to have a full abdominal hysterectomy in Feb (given my anatomy, I do not qualify for total lapro). As my dysphoria seems to get worse regarding incompleteness in the lower region, I too have been researching surgeons. I know about Canada MSP coverage but I don’t trust what I have read on results. I would not hesitate to see Dr.Miro in Belgrade but that would require robbing a couple of banks. I’ve been following your awesome blog here and appreciate just how much information you have been providing transfolk. I’m curious regarding how the cream is helping growth for you “there” AND how you found Dr. Crane. Anyways, I really want to thank you for inspiring me as you have. You are truly a huge huge inspiration and fountain of information to all of us, especailly Canadians!!!!
Congratulations on your recent and upcoming surgeries!
As for bottom surgery, MSP coverage here in BC is a reality, but the program seems to be rolling out slowly. As of now, they are not funding any surgeons other than Dr. Brassard in Montreal. The waiting list is close to 5 years long so if this is something you are considering, it would be a good idea to get yourself on that list. To do that, your doctor needs to submit a request to MSP for metoidioplasty or phalloplasty funding.
I first learned of Dr. Crane… I’m not exactly sure actually, it was probably a mailing list or on Facebook. I’m very confident in his abilities, and really like that he’s a urologist and able to work around the complication I had from my hysterectomy. MSP coverage or not, he’s my surgeon.
It’s great to hear you’ve found this blog helpful, thank you!
I thought I would get this out on your blog as I feel us guys on the BC lower surgery waiting list should all share our concerns with BC MSP only funding Dr. Brassard. I contacted Dr. Brassard’s clinic in January requesting photos of the results of their phalloplasty surgeries and they sent a couple of photos during surgery only. So then I emailed them again requesting after surgery photos and testimonials from those that have had surgery with him. No reply and it’s been over a month now. So then I surfed the net trying to find any FTMs that had gone to Dr. Brassard for the lower surgery and not much except for:
By: Isaac
I would never recommend any female-to-male go to Brassard. FTMs should go to Europe..light years better.
Email: Date added: Mar 17, 2011
And take note that Dr. Brassard has performed some 1,500 gender reassignment surgeries in the past 13 years and about 75 percent of the gender reassignment surgeries he performs are on Male-to-Females, who all seem to have glowing remarks.
I talked to Dr. Cameron Bowman who does SRS in BC (he did my chest surgery) and he trained with Dr. Brassard in Europe. So, here we have a surgeon in our province who can do these operations but we can not see him! He also said he had concerns with post op, in that if we have complications we are to fly back to Montreal. How often would this be?
I think we all need to share our concerns with the BC MSP contact.
I want phalloplasty by the way.
Thanks for your comments, Alex!
Unlike top surgery, lower surgery photos are not as commonly shown on surgeon websites or emailed. My understanding is that Dr. Brassard will show you photos during your in-person pre-op consultation (for which you will have to foot the travel bill.) Similarly, testimonials of lower surgery are found less often online, for privacy and because a lot of guys just move out of the “community” at that stage.
I have read fairly extensive reports of phalloplasty with Dr. Brassard and I admit that the tone was indeed not in the positive (and I’ve read similar stories from women as well.)
There are several reasons why I’m not suited to having surgery with Dr. Brassard, and I presume there are others in BC who would go to another surgeon given the choice. Unfortunately, I’m also not suited to having phalloplasty with Dr. Bowman.
Yes, post-op complications can and do occur. I have a local urologist who is willing to work with me should I require immediate care, but if there are serious issues I would need to fly back to my surgeon. This would likely be the case even if Dr. Bowman could help, because he was not trained in the phalloplasty procedure that I want. Dr. Bowman also did not receive training in metoidioplasty, so BC guys headed for that surgery would not necessarily be able to rely on him for post-op care either (especially for urological problems.)
I don’t know the details behind MSP’s choices, but this is somewhat similar to what’s happened in BC with top surgery: Dr. Bowman had the training but could not get OR time. Patients were sent to Montreal. Eventually, he was granted some OR time and now performs BC’s funded top surgeries. It’s not easy to predict whether or not this same course of events could happen for phalloplasty though because the OR time is considerably longer and patients need to remain in the hospital for a week or more. Furthermore, once these are in place, Dr. Bowman will need a urologist on board. (There have been at least a couple of interested Drs. but without that OR/patient stay issue resolved they couldn’t sign on to anything.)
Because Dr. Brassard is not an option for me, I plan to present my case to MSP and lobby for alternative funding. Hopefully, other guys in similar situations will do the same. If we don’t ask for something, we won’t get it. This is one of the huge reasons why there wasn’t phalloplasty funding here for a while: MSP said they weren’t aware that there were guys who wanted the funding. How would they know unless requests were coming in from their docs? Because it was known that there was no funding, few guys were requesting it. So yes I completely agree Alex, if you have concerns with what MSP is funding and how that relates to your needs, relay those concerns to MSP and concisely ask for what you need. (And by “you” here, I mean the global you.) MSP has funded out of country surgeons for SRS in the past (Dr. Meltzer) so why not again? OHIP now funds out of country SRS surgeons. How was that achieved? I think there’s some wiggle room here, at least, I’m hopeful!
(Note: Dr. Bowman trained with Dr. Monstrey in Europe, not Dr. Brassard.)
Starting my first shot of Test cyp. Today !! I’ve been back and forth to Different Dr’s for 5 years complaining of depression, fatigue, aching joints and an overall sense of Malaise. I am a straight 45 yr old male but to suffer is to suffer, regardless of disposition, and I have suffered…..After 5 yrs my new Dr. suggested a testosterone test and it revealed that I had the levels of a 95 yr old man…Yikes….Long story short The pharmacy is filling my order as we speak and as soon as it’s ready in a bit I will go get it ($16 USD) and self inject. I am so excited to finally be treated. It is a horrid feeling to be a man on the outside but not feel like one on the inside…Can really suck the fight out of you..Thank you for your blog Outlaw. as now I know at least a little bit of what to expect…If anyone can share what it might be like over the next few weeks/months feel free to comment as I will check back often…Again thanks to all who have shared, David
Your journey is very close to mine. I had a down payment to Dr. Bowers for Metoidioplasty, and when I found out that my chest surgeon Dr. Brownstien, recommended Dr. Crane who does Phalloplasty, I changed my mind and am on the schedule for Phallo this September. I am excited because this is what I really wanted but was settleing for meta.
Does anyone know if it is better to bury the clitoris in the base of the Phallus, or leave it exposed under the phallus?
Thanks for your comments! On burying the clitoris: it’s a moot point if the phalloplasty procedure includes nerve anastomosis (connection of clitoral nerves to donor flap nerves.) In the case of other types of phalloplasty without this nerve hookup, such as the hip/groin or abdominal flap phalloplasties, it’s a highly personal choice. Some guys need it buried, other guys want some access to it.
This was one of the factors that pushed me from hip/groin flap phalloplasty to ALT: I didn’t want to have to make that decision. With ALT, I don’t have to.
Thanks for this information on your Road to Phalloplasty. I would like to know where you are at with your decision surrounding the procedure. Are you going to be updating us soon?
yes I would like to know what has happened since you last posted as well. Thanks I found your blog yesterday, very nice transition! I am just starting out on my journey.
Has there been any more progress along the road? This has been a hugely helpful blog.
I have also chosen Dr crane as my surgeon and will be moving to BC at the end of this year. I was just curious if anything came from your attempts at getting out of country funding? Thanks for posting this, it’s been a huge help.
Unfortunately, no one has been funded for phalloplasty in BC yet. And no one can say when money will start moving. And there’s a 10 year wait list! If you’re hoping for gov funded bottom surgery in BC, you will have a considerable wait. As for out of country funding, it’s a matter of mounting a case for why the Canadian surgeon is not an option for you. Since no one has been funded yet, it’s impossible to say what MSP’s criteria will be for approving out of country funding. At least there’s precedence in Ontario. Sorry I can’t provide better news. The situation is very frustrating for me.